The Care Quality Commission
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Archived: Sevacare - Haringey

Overall: Requires improvement read more about inspection ratings

4th Floor Belmont House, 78-80 High Road, Wood Green, London, N22 6HE (020) 8826 3270

Provided and run by:
Sevacare (UK) Limited

All Inspections

24 and 30/06/2015

During an inspection looking at part of the service

Sevacare (UK) Limited is a national provider of care and support services to people in their own homes. ‘Sevacare – Haringey’ provides personal care to people of any age living in Haringey who need care due to ill health or disability.

We carried out a comprehensive inspection of this service on 14 and 15 December 2014. We found seven breaches of legal requirements, which put people using the service at significant risk of receiving inappropriate or unsafe care. You can read the report of this inspection, by selecting the 'all reports' link for this service on our website at www.cqc.org.uk

We took enforcement action against the registered persons, including cancelling the registration of the previous manager of the service, and proposing to remove the location ‘Sevacare – Haringey’ from the registration of the provider, Sevacare (UK) Limited.

We undertook this unannounced comprehensive inspection, of 24 and 30 June 2015, to check on the progress the provider had made to address our concerns from the previous inspection, and to check on the standard of care people using the service were receiving. At the time of this inspection the agency was providing a care service to over 270 people in their own homes, which meant just under 4000 hours of service per week. Since our last inspection, the provider had moved its service for people in another local authority to a different location.

Whilst we found evidence to demonstrate that some of our concerns had been addressed, we found breaches of three legal requirements. This continued to put people using the service at unnecessary risk of receiving inappropriate or unsafe care.

We continued to find instances where people’s scheduled visits did not occur as planned, because the visits were either missed or shorter than planned for. There was evidence of insufficient staff travel time in-between visits to people. Where people had electronic call-monitoring systems to check on the times of staff entering and leaving their home, these were not consistently used. People’s care needs and preferences were not always met in these instances.

We continued to find that people were not being supported to manage their medicines safely. This was because medicine records had not been consistently filled in to demonstrate that people had been supported to take their medicines as prescribed.

There remained shortfalls in the effectiveness of the provider’s governance of the service. Whilst a number of audit tools were now being used effectively to address potential service risks, weekly reports to senior managers continued to omit information on missed visits and safeguarding cases. Checks of care delivery records continued not to identify risks around medicines management. Where a person had requested a care worker to be excluded from visiting them, or a safeguarding case had recommended an exclusion, we found that systems to ensure this were not effective.

Records were now provided to us in full when we requested them. However, we still found some records were not accurate or up-to-date. This undermined, for example, explanations provided by the service into other concerns of ours, because there were sometimes no records to support what we were being told. Whilst there was evidence of complaints and safeguarding matters being attended to, records did not always demonstrate effective operation of these processes.

Staff now had up-to-date training, supervision and appraisal. However, we were not assured that these processes were being productively used to support staff to provide appropriate care for people, because, for example, some parts of the appraisal were not filled in. Most of the recorded content on care workers’ supervision forms was similar, with little specific to each individual care worker’s needs.

Staff were aware of the practical applications of the Mental Capacity Act 2005, however, this Act was inconsistently applied within care documentation.

However, a number of improvements had occurred since our last inspection. There was improved feedback about the approach of care workers. Most people using the service valued the relationships they had with staff and expressed satisfaction with the care they received. We found that people now received a consistent set of care workers with whom they developed positive, caring relationships.

There was no registered manager in post on the dates of the inspection visits. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. A new manager had been appointed since our last inspection, whom we met during this inspection. Their registration as manager was completed whilst this report was being drafted. There was positive feedback from people using the service and staff about the new manager’s approach. Everyone had had a face-to-face review of their care needs, care plans were up-to-date, and there was improved feedback from people and their representatives about receiving personalised care.

People’s formal complaints were now being responded to promptly, with apologies for service shortfalls where appropriate and action plans being communicated to complainants. Expressions of dissatisfaction were also being addressed.

The service was taking steps to protect people from the risk of abuse. Allegations of abuse were now being notified to us, and the service was alerting the local safeguarding authority about safeguarding concerns that care staff were raising, to help protect people.

Appropriate recruitment checks took place before new staff started work. Disciplinary processes were now being used to help ensure that established staff were suitable to work with people.

People received sufficient support with food and drink, and appropriate support to maintain good health, including through referrals to community healthcare professionals.

We found overall that people using the service continued to be at some risk of receiving inappropriate or unsafe care. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Following this inspection we continued with our enforcement action. The action we took was to serve a notice proposing to remove the location ‘Sevacare – Haringey’ from the registration of the provider, Sevacare (UK) Limited.

Due process was followed which meant that the Care Quality Commission removed the location ‘Sevacare – Haringey’ from the registration of the provider, Sevacare (UK) Limited, on 4 April 2016.

15 and 16/12/2014

During an inspection looking at part of the service

This unannounced inspection took place on 15 and 16 December 2014. Our previous inspection of 3 January 2014 found that the service had made improvements and met standards relating to care and welfare of people using the service, quality and risk management, complaints, and safeguarding notifications.

Sevacare (UK) Limited is a national provider of care and support services to people in their own homes. ‘Sevacare – Haringey’ provides personal care to people of any age living in the local area who need care due to ill health or disability. At the time of this inspection the agency was providing a care service to over 550 people in their own homes. This included over 200 people who started using the service in June 2014 when the provider accepted a contract with a neighbouring local authority to provide services in that area.

At the time of our visit, the service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found that a number of breaches of legal requirements. This put people using the service at significant risk of receiving inappropriate or unsafe care.

People provided us with mixed views on the services they received. Whilst some people praised their regular care workers, some people told us of feeling rushed during care visits and care workers not listening to them. We found that some people received care visits that were shorter than half their allocated time, and that some people did not receive a consistent set of care workers who got to know their individual care needs and preferences. This meant people were not always treated in a caring way that met their individual needs.

We found instances where people’s scheduled visits did not occur as planned. This included very late visits or where only one of two planned care workers attended. This compromised people’s safety and wellbeing. These matters were not investigated, and were not routinely reported to senior managers, so that action could be taken to prevent reoccurrence.

We found that people were not being supported to manage their medicines safely. Most medicines records we saw had not been consistently filled in to demonstrate that people had been supported to take their medicines as prescribed.

We found that people’s recent complaints were not identified as complaints and addressed. Some older complaints had not been addressed in a timely manner. This meant people were not listened to, and action was not taken to prevent any unsafe or inappropriate care that was being reported.

Safeguarding processes did not always keep people safe from abuse. The provider and manager had not informed us of any allegations of abuse relating to services provided by the agency in more than seven months, and had not kept a clear record of these allegations and their responses.

We found that care workers were inconsistently trained, supervised and supported. Many staff who transferred from another agency in June 2014 had not had any supervision or refresher training. Staff were not supported to deliver care to people safely and to an appropriate standard.

Some people’s care plans and care delivery records showed that their individual needs were not being responded to, for example, by continuing to schedule home visits when the person was at a regular community appointment.

Most people who started using the agency in June 2014 had not yet had a review meeting, to check how effective their care package was. When review meetings occurred, these did not always result in care delivery concerns being addressed. This approach did not protect people from the risks of inappropriate or unsafe care.

Feedback indicated that it was not easy to access the provider’s out-of-hours on-call team. We found that the on-call team relied on there being an accurate and up-to-date statement of each person’s care package on the provider’s computer system, which was often not the case.

This meant they could not always respond effectively when anyone phoned them, for example, to replace a care worker who could not attend to someone.

Audit tools used to check on the management of the service were not always accurate and up-to-date, and action was not taken when the tools identified risks to the welfare of people using the service and staff.

Records were not always provided to us in full when we requested them, which undermined our confidence in the transparency and management of the service.

Due to the many concerns that we found, we did not have confidence in the manager and provider’s oversight of quality and risk at the agency, and concluded that the service is not well-led.

We found overall that people using the service were at significant risk of receiving inappropriate or unsafe care. We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

As a result of this inspection, we served enforcement notices proposing to cancel the registration of the manager and to remove the location ‘Sevacare – Haringey’ from the registration of the provider Sevacare (UK) Limited.

3, 7 January 2014

During an inspection looking at part of the service

We carried out this inspection to check whether actions which required actions taken after our previous inspection in September 2013 had been carried out. At the previous inspection we found that Sevacare Haringey was not compliant with regulations 9, 10,18 and 19 of the Health and Social Care Act 2008. We received an action plan from the provider and this inspection took place to see whether this had been effective.

During this inspection, we spoke with the management of Sevacare Haringey, we spoke with care workers, people who used the service, their families and representatives, and we looked the the records. We checked the systems the provider had in place to check the quality of their service and we sent out questionnaires to a sample of people who used the service to gather feedback.

Most people we spoke with told us that they found the service helpful and they appreciated the service they received from their care workers. One person told us "these carers are lovely" and another told us "they're polite, very pleasant". Most people told us that their care workers were usually on time.

Care workers we spoke with told us that they found the new monitoring system, which had been introduced since our previous inspection, had been helpful to them. One told us "Since September things have improved a lot, we have more travelling time now. It's an improvement. I get supervision a lot". Another care worker told us "we are more punctual, it's better now".

We saw that the complaints policy had been given to people and most people told us they knew how to make a complaint. We spoke with one person who had made a complaint and felt the response had been adequate. We saw complaints that had been made since the last inspection and saw that the process to manage them was covered by the current complaints policy.

Since the last inspection appropriate notifications had been made to the Care Quality Commission (CQC) when there had been an allegation of abuse.

2, 4 September 2013

During an inspection looking at part of the service

We visited Sevacare Haringey offices over two days and looked at the files and records for fifteen service users and five members of staff. We spoke with care workers and staff based in the office as well as the registered manager. We spoke with twenty two people or their relatives who used the service.

Most people told us they were treated with respect. People had care plans which were in their homes and most of the care plans were signed which indicated that people were aware of them. Some did not have preferences noted.

Care plans were reviewed annually. We found that sometimes the risks identified were not evidenced in the risk management plans. Most people we spoke with were happy with the care provided, however, people told us that they were concerned about timekeeping and late visits.

Staff had regular supervision and training. Most staff had an understanding of safeguarding and what they should do if they had concerns. People told us they felt safe with the care workers who worked with them. Some incidents which should have been notified to the CQC had not been.

The provider did not have systems for assessing and monitoring the quality of the service. They did not always take account of people's views. The provider had a complaints policy but it was not always followed. Some records were not immediately accessible or accurate.

22 February 2013

During an inspection looking at part of the service

We spoke with a small sample of five people using the service and and relatives of five other people using the service. The overall view of these ten people was that they were happy with the quality of care they received from their Sevacare care workers. One person said their care worker was "absolutely excellent" and two said they were "quite happy" with the care provided to them. There were mixed views about whether the care worker arrived at the agreed time. People generally felt the support and service from office based managers could be improved. One said that nobody from the office had phoned or visited them to check if they were satisfied with the service for several months, though they had responded when she phoned them. One person said that they felt there was "gross inefficiency" as staff did not reply to telephone messages. Three people said they were satisfied with the support from office staff and that they received calls from them if their care worker was going to be late.

We found that the agency's quality assurance processes did not always address late and missed calls to ensure the number of them reduced and people were satisified that they always received their agreed care.

26 April 2012

During a routine inspection

We spoke with five people who used the service and three of their relatives. People complimented the carers and said that carers respected them and treated them with dignity. People told us that overall their needs were being met, however there were sometimes inconsistencies between carers in relation to this. People said that carer's timekeeping was mostly good, but could also vary sometimes between carers. People told us that the service regularly asked them if they were happy and for their views about their service. Two people told us that the agency did not promptly respond to their complaints, but people knew how to complain and those we spoke to mostly said they did not have any major complaints. During this review we found that the service needed to improve the way it safeguards people from neglect and abuse. This included that all staff take appropriate action to prevent people from suffering neglect and abuse and that the agency takes prompt and appropriate action with staff if abuse occurs. The agency was unable to provide information about how many visits had been missed over the year and so the extent to which there was an impact on people and their needs being neglected was not known. A system was needed to assess and monitor this to ensure the overall quality and effectiveness of the service. This would allow the provider to help identify patterns or trends in how the service was provided and ensure that they continued to provide a safe and quality service.